title: Preoperative prediction of the individualized risk of early fetal death after laser therapy in twin-to-twin transfusion syndrome.
abstract: OBJECTIVE
  The aim of this study is to evaluate the independent and combined value of gestational age, fetal weight, fetoplacental Doppler, and myocardial performance index for the prediction of individual risk of early (≤7 days) intrauterine fetal death (IUFD) after laser therapy in twin-to-twin transfusion syndrome (TTTS).
  
  
  METHODS
  A consecutive series of 215 cases of TTTS treated with laser therapy in three centers was prospectively studied. Ultrasound evaluation within 24 h of surgery included estimated fetal weight discordance, umbilical artery, pulsatility index (PI) and diastolic flow evaluation, middle cerebral artery PI and middle cerebral artery peak systolic velocity, ductus venosus PI and atrial flow assessment, and modified myocardial performance index. Logistic regression analysis was used to explore the association of preoperative parameters with IUFD.
  
  
  RESULTS
  Intrauterine fetal death occurred in 17 (7.9%) of the recipients and 33 (15.3%) donors (p = 0.016). The only independent predictors of IUFD in recipients was the middle cerebral artery peak systolic velocity >1.5 MoM (OR = 22, p = 0.015), but this event was present in only 3% of recipients. In donors, reverse end diastolic flow in the umbilical artery (OR = 14.748, p = 0.033), estimated fetal weight discordance (OR = 1.054, p = 0.036), and gestational age (OR = 0.757, p = 0.046) were independent predictors.
  
  
  CONCLUSIONS
  In TTTS, preoperative fetal assessment can identify independent risk factors for early post-operative IUFD, particularly in donors.
authors.affiliation: Department of Maternal-Fetal Medicine, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Hospital Clinic, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain.
authors.forename: Elisenda
authors.initials: E
authors.lastname: Eixarch
authors.forename: Dan
authors.initials: D
authors.lastname: Valsky
authors.forename: Jan
authors.initials: J
authors.lastname: Deprest
authors.forename: Ahmet A
authors.initials: AA
authors.lastname: Baschat
authors.forename: Liesbeth
authors.initials: L
authors.lastname: Lewi
authors.forename: Javier U
authors.initials: JU
authors.lastname: Ortiz
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Martinez-Crespo
authors.forename: Eduard
authors.initials: E
authors.lastname: Gratacos
mesh_terms: D005260:Female; D005313:Fetal Death / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D020567:Fetal Weight; D005330:Fetofetal Transfusion / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D005332:Fetoscopy / Q000401:mortality*; D005865:Gestational Age; D006801:Humans; D007206:Individuality; D053685:Laser Therapy / Q000401:mortality*; D011247:Pregnancy; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014430:Twins, Monozygotic; D018608:Ultrasonography, Doppler; D016216:Ultrasonography, Prenatal